The hallucal interphalangeal ossicle: anatomy and basis for ultrasound-guided surgical shaving

Abstract

Painful lesions on the plantar aspect of the first interphalangeal joint (IPJ) of the hallux can be attributed to structures called ossicles, nodules, or sesamoids. The aims of the present study were first to verify that ultrasonography (US) is a high-sensitivity tool for diagnosing an interphalangeal ossicle (IO), and second to prove that US-guided-shaving surgery (“milling”) is a safe and feasible technique for remodeling the IO. The study is divided into three parts. In the first part, the prevalence of IOs was estimated in 12 cadaver feet using US, anatomical dissection, and fluoroscopy. In the second, a detailed US and morphological description of the IO was obtained. In the third, six cadaver feet were subjected to surgical milling. IO prevalence was 41.6% in gross anatomy, 41.6% in US examination and just 16.6% in fluoroscopy. The ossicles had a mean length of 4 mm (± 2 mm) and a width of 7 mm (± 2 mm). The ossicles could be completely shaved in all specimens without injuring important anatomical structures. Our results indicate that US is a more precise tool for diagnosing an IO than X-ray. Moreover, our US-guided mini-invasive surgical technique appears feasible and safe.

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…By standardizing other surgical variables through the cadaver model, we could directly quantify the differences in angular precision between conventional freehand osteotomies and those conducted using the inclinometer. This controlled comparative testing in cadavers paralleled similar research modalities in orthopedic surgery examining techniques [32][33][34][35]. Our cadaveric protocol and testing methods reinforced the validity and potential generalizability of our findings.…”

“…The data solidly support the fact that the inclinometer-assisted surgeries lead to more consistent and predictable decreases in pressure figures post-intervention compared to surgeries performed without the inclinometer (Figure 8). 35; p < 0.001), underlining the substantial difference in outcomes. This effect size, indicative of the magnitude of the difference between the groups, emphasizes the pronounced impact and statistical significance favoring the utilization of the inclinometer.…”

Plantar Plate Repair using Suture Anchors for Chronic Plantar Plate Rupture of the first Interphalangeal Joint in a Pediatric Patient: A Case Report

“…Several components contribute to the stability of the IP joint of the great toe, including the flexor and extensor hallucis longus tendons, collateral ligaments, capsule, and plantar plate [ 7 ]. The plantar plate is a thick, fibrocartilaginous pad formed by the condensation of the collateral and capsular ligaments [ 8 ], and the plantar plate of the IP joint is inserted proximally to the condyle of the proximal phalanx and distally to the condyle of the base of the distal phalanx [ 9 ]. The plantar plate prevents hyperextension of the IP joint as a static stabilizer [ 7 ].…”

Resolución quirúrgica de un sesamoideo interfalángico del hallux

“…De cara a la resolución quirúrgica consideramos dos opciones: la cirugía a campo abierto o la cirugía mínimamente invasiva mediante control ecográfi co y fl uoroscópico. Si bien recientemente ha sido descrito el abordaje mínimamente invasivo mediante control ecográfi co 6 , en esta ocasión optamos por un abordaje a campo abierto ante la peculiaridad del caso y el riesgo de dañar el tendón fl exor largo, cuya vascularización a este nivel depende de unas pequeñas vínculas que podrían resultar muy vulnerables si no están perfectamente identifi cadas 1,9 . Recientemente también se han descrito abordajes mediante artroscopia para problemas articulares en esta localización 10 .…”

“…No obstante, para complementar el estudio se realizó un examen ecográfico en cortes, tanto longitudinal como transverso, mediante sonda lineal 14 Mhz con ecógrafo Vinno E35 (Vinno Spain, Vinno Ultrasound S.L.U., Barcelona, España). El estudio mediante ecografía se ha mostrado muy útil en estos casos, ya que permite identificar con mayor precisión estructuras tanto osificadas como no osificadas 6 .…”